Journal of neurosurgery
-
Journal of neurosurgery · Mar 2018
Endoscopic endonasal resection of the odontoid process: clinical outcomes in 34 adults.
OBJECTIVE Treatment of odontoid disease from a ventral corridor has consisted of a transoral approach. More recently, the endoscopic endonasal approach (EEA) has been used to access odontoid pathology. METHODS A retrospective review was conducted of patients who underwent an EEA for odontoid pathology from 2004 to 2013. ⋯ The 90-day perioperative mortality rate was 2.9%. CONCLUSIONS A completely EEA can be performed for compressive odontoid disease in all cases of neoplastic, degenerative, or invaginative atlantoaxial disease with satisfactory outcomes and low morbidity. Transient perioperative dysphagia and respiratory complications are common, usually as an exacerbation and reflection of underlying disease or occipitocervical fusion rather than the EEA, emphasizing the importance of avoiding transoral surgery.
-
Journal of neurosurgery · Mar 2018
William Edward Gallie (1882-1959): father of the Gallie wiring technique for atlantoaxial arthrodesis.
William Edward Gallie (1882-1959) was a Canadian general surgeon with special expertise in orthopedic surgery. His experience with surgical management of cervical spine subluxation led him to invent a method of cervical wiring of the atlas to the axis. ⋯ Gallie is also hailed for instituting the first surgical training program in Canada, a curriculum his pupils memorialized as the "Gallie course" in surgery. In this historical vignette, the authors describe Gallie's life and depict his contributions to surgery.
-
Journal of neurosurgery · Mar 2018
Outcomes after hemispherectomy in adult patients with intractable epilepsy: institutional experience and systematic review of the literature.
OBJECTIVE Hemispherectomy is a surgical technique that is established as a standard treatment in appropriately selected patients with drug-resistant epilepsy. It has proven to be successful in pediatric patients with unilateral hemispheric lesions but is underutilized in adults. This study retrospectively evaluated the clinical outcomes after hemispherectomy in adult patients with refractory epilepsy. ⋯ Among the 41 patients who underwent additional formal neuropsychological testing postoperatively, overall stability or improvement was seen. CONCLUSIONS Hemispherectomy is a valuable surgical tool for properly selected adult patients with pre-existing hemiparesis and intractable epilepsy. In published cases, as well as in this series, the procedure has overall been well tolerated without significant morbidity, and the majority of patients have been rendered free of seizures.
-
Journal of neurosurgery · Mar 2018
Meta AnalysisMeta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults.
OBJECTIVE The purpose of this study was to evaluate treatment outcomes of future stroke prevention, perioperative complications, and angiographic revascularization in adults with symptomatic moyamoya disease (MMD) according to treatment modalities and surgical techniques. METHODS A systemic literature review was performed based on searches of the PubMed, Embase, and Cochrane Central databases. A fixed-effects model was used in cases of heterogeneity less than 50%. ⋯ Direct bypass was associated with better angiographic outcomes than indirect bypass (OR 6.832, p < 0.001). CONCLUSIONS Bypass surgery can be effective in preventing future stoke events in adults with MMD. Direct bypass seems to provide better risk reduction with respect to stroke than indirect bypass in these patients.
-
Journal of neurosurgery · Mar 2018
Meta AnalysisNeuropsychological function after endovascular and neurosurgical treatment of subarachnoid hemorrhage: a systematic review and meta-analysis.
OBJECTIVE Subarachnoid hemorrhage (SAH) is treated with either surgical clipping or endovascular coiling, though the latter is the preferred treatment method given its more favorable functional outcomes. However, neuropsychological functioning after treatment is rarely taken into account. In this meta-analysis, the authors synthesized relevant data from the literature and compared neuropsychological functioning in patients after coiling and clipping of SAH. ⋯ Coiled patients outperformed clipped patients to a greater degree in more recent publications, over longer posttreatment testing delays, and among older patients. Higher rates of posterior circulation and MCA aneurysms were associated with smaller group differences, while ACoA rupture rates did not influence effect sizes. CONCLUSIONS Coiling of SAH may promote superior neuropsychological functioning under certain circumstances and could have applications for the specialized care of SAH patients.